Friol Alice, Dumas Guillaume, Pène Frédéric, Demoule Alexandre, Kouatchet Achille, Argaud Laurent, Bigé Naike, Moreau Anne-Sophie, Barbier François, Mokart Djamel, Lemiale Virginie, Azoulay Elie
Medical Intensive Care Unit, AP-HP, Saint-Louis Hospital, Paris-Cité University, INSERM UMR1342 Institut de Recherche Saint-Louis, Paris, France.
Université Paris Cité, Assistance Publique - Hôpitaux de Paris, Hôpital Cochin, Service de Médecine Intensive Réanimation, Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France.
Intensive Care Med. 2025 Jan;51(1):72-81. doi: 10.1007/s00134-024-07767-z. Epub 2025 Jan 24.
Invasive pulmonary aspergillosis (IPA) is a life-threatening opportunistic infection in immunocompromised patients. The diagnosis is often made late, with mortality reaching 90% when mechanical ventilation is needed. We sought to develop and validate a risk prediction model for the diagnosis of IPA.
We used two independent datasets of immunocompromised patients with acute respiratory failure admitted to 12 intensive care units (ICUs). The derivation dataset include 3262 patients. Factors associated with probable or proven IPA were identified, and a risk prediction model was developed. This model was then validated in a prospective dataset (776 patients).
IPA prevalence was 4.5% (146/3262) and 3.3% (26/776), in the derivation and the validation cohorts, respectively. The final model included eight variables constitutive of the IPA-GRRR-OH score: type of immunosuppression, high-dose or long-term corticosteroids, neutropenia, the presence of structural lung disease, time from symptoms onset to ICU admission > 7 days, hemoptysis, focal alveolar pattern on the chest imaging, and viral co-infection. The median score [IQR] was 2 [1-3] in the derivation and 1 [0-3] in the validation cohort. The best cutoff score for IPA diagnosis was 4 (sensitivity 23.1%; specificity 90.5%; negative predictive value 91.4%). Discrimination and calibration were good in both the derivation (AUC 0.72 [0.68-0.76]) and the validation cohort (AUC 0.85 [0.76-0.93]).
The IPA-GRRR-OH is a clinical score, easily available at ICU admission, which reliably predicts IPA in immunocompromised patients with acute respiratory failure. Studies to demonstrate benefits from the bedside implementation of this score are warranted.
侵袭性肺曲霉病（IPA）是免疫功能低下患者中一种危及生命的机会性感染。诊断往往较晚，在需要机械通气时死亡率可达90%。我们试图开发并验证一种用于诊断IPA的风险预测模型。
我们使用了两个独立的数据集，这些数据集来自入住12个重症监护病房（ICU）的免疫功能低下且患有急性呼吸衰竭的患者。推导数据集包括3262例患者。确定与可能或确诊的IPA相关的因素，并开发了一个风险预测模型。然后在一个前瞻性数据集（776例患者）中对该模型进行验证。
推导队列和验证队列中IPA的患病率分别为4.5%（146/3262）和3.3%（26/776）。最终模型包括构成IPA-GRRR-OH评分的八个变量：免疫抑制类型、高剂量或长期使用皮质类固醇、中性粒细胞减少、存在结构性肺病、从症状出现到入住ICU的时间>7天、咯血、胸部影像学上的局灶性肺泡模式以及病毒合并感染。推导队列中的中位数评分[四分位间距]为2[1-3]，验证队列中为1[0-3]。IPA诊断的最佳临界评分为4（敏感性23.1%；特异性90.5%；阴性预测值91.4%）。推导队列（AUC 0.72[0.68-0.76]）和验证队列（AUC 0.85[0.76-0.93]）的辨别力和校准效果均良好。
IPA-GRRR-OH是一种临床评分，在入住ICU时易于获得，可可靠地预测免疫功能低下且患有急性呼吸衰竭患者的IPA。有必要开展研究以证明床边应用该评分的益处。
